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GPs go forth

QOF has led to no significant improvement in mortality rates, says study

The QOF has led to no significant improvement in mortality rates for medical conditions covered, a Lancet study has claimed.

Researchers looked at data from 27 high-income countries, comparing death rates for conditions covered by, and not covered by, QOF.

The study, which looked at death rates in the UK between 1994 and 2010, found that QOF was related to a small, not statistically significant, decrease in death rates for heart disease and a small increase in death rates for non-targeted conditions.

It comes as in England, the Government and GPC had agreed to look at ’completely’ getting rid of QOF as early as next year. Meanwhile, in Scotland, the scheme is already largely scrapped.

Despite £5.86 billion being spent on the scheme’s incentive payments in the first seven years of the scheme, ‘QOF was not associated with significant changes in mortality’, researchers said.

They found that in the UK, the mortality rates for conditions in the QOF decreased by four per 100,000 patients, while for conditions not covered mortality rates increased by 12, when compared to the other countries. For ischaemic heart disease, mortality rates dropped by 11.

The paper said: ’Our results show that introduction of the QOF in the UK was not significantly associated with changes in population mortality for disease areas that were targeted by the programme. We recorded that the QOF was also not significantly associated with changes in mortality for disease areas that were not targeted by the programme.

The researchers, from the University of Michigan, University of Manchester and University of York, said that their study ’provides the first cross-national evidence for the effects of pay-for-performance on population health.’

They wrote: ’Extensive research into pay-for-performance programmes has yet to show clear patient benefits.

’The apparent failure of such a large and sustained programme to reduce mortality suggests that faults might exist in the general approach of use of financial incentives to improve population outcomes or in the specific design of the QOF.’

The study said that the effects of improved primary care on death rates could actually be ‘slight’ in comparison with other socio-economic factors. It added that QOF could possibly have improved non-fatal outcomes but the study did not cover those cases.

Commenting on the study, Professor Martin Roland, former GP and professor of health sciences at the University of Cambridge, said the research ’emphasises the importance of a primary care system that provides universal coverage with a strong preventive component and the important role of doctors in advocating for measures to reduce behaviours that lead to ill health and premature death’.

A Department of Health spokesperson said: ’We recognise GPs are under a lot of pressure and have already revised the QOF to remove ten-minute minimum slots for booked appointments, as well as reducing unnecessary paperwork for GPs so that they can spend more time with patients.

’NHS England has agreed to undertake a review of QOF in the coming year, to see how we can best manage the system for the future.’

QOF could be scrapped ‘in its entirety’ by next year

The GPC and the Government have agreed to ’explore’ a complete scrapping of QOF in England, with the framework remaining unchanged for 2016/17.

In Scotland, QOF achievement is no longer linked to practice payments.

Health secretary Jeremy Hunt has repeatedly hinted at the removal of QOF, including telling Pulse last year that he was ‘not a fan’ of such financial incentives. However, he has also indicated that he wishes GPs to continue to record clinical outcomes against the framework.

Somerset was the first area of England to get rid of QOF and work to a local alternative scheme in 2014, with initial evaluation of the project revealing it had not led to impaired clinical outcomes.

The report found that dropping the QOF has freed up GPs to offer patients more holistic, person-centred and co-ordinated care – without any reduction in measures of quality.

Readers' comments (23)

  • Bob Hodges

    What may be the case is that the other countries' primary care systems have adopted best practice at the same time, hence our outcomes have 'tracked' theirs.

    We've probably done it in a more cost effective way in terms of share of GDP, and done it fewer doctors whilst simultaneously dealing with a near doubling of our total workload.

    Without QoF, things might have been a lot worse. Comparing outcomes in QoF conditions with non-QoF conditions seems like an apple:pear comparison interface issue.

    QoF has unwittingly lead to the development of primary care teams with nurses and pharmacists taking on (entirely appropriately) work which would otherwise have been done by the GP. I think we're in a better place to achieve the next step of the evolution that we need to survive as a result.

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  • No effect on mortality? Not surprised. We all die eventually.

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  • I'm sure the smoking ban has had more effect on life expectancy than QoF. But as a colleague pointed out , the mortality rate is always 100%

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  • I am really not convinced that anyone would expect to see changes within 7 years as lot of the parameters likely to take longer to have an effect.
    Surely there must be some benefit for all those hours I spent in front of the computer before my departure to Australia?

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  • Unlikely thay even GP's can change death rates in 7 years, despite the fact that we are responsible and accountable for all the ills in the universe apparently. I think that there has been a lot of collateral benefits which are not entirely measurable in terms of chronic disease management

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  • Scrap it ,if we dont get paid to tick these political boxes why should we do them.

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  • Seems to me we have conducted the biggest experiment in mass medicalisation in the world and what do all those statins, ACE inhibitors, betablockers and inhalers etc achieve??
    It is apparent real life figures do not concord with pharma funded research.
    Maybe the drugs don't work!

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  • what's the mortality and (mental) morbidity rates amongst GPs since CQC has been introduced? Did I hear 'high'?

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  • While QoF certainly has benefited some reluctant patients who have been literally extricated from their homes by a barrage of telephone calls and letters to come in for their diabetic or other checks, it has had a negative impact by depriving the general population of care by stealing time from them. Dropping QoF has takers but the concern is that funding from QoF liquidation is going to evaporate.
    The resultant increase from the points dropped so far has been a pittance compared to the loss of income and that is where patient care could suffer.
    Good or bad, QoF helped Practices to survive by complementing essential funding. It remains to be seen whether the government has the will to maintain the level of resources in Primary Care and will not discriminate with redistribution of funding saved by giving big chunks to conglomerates with 30,000 or more patients and leave in lurch smaller Practices.

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  • Europe do how many health checks, for which ther is no evidence?
    We do health checks of the worried well to supplement diminishing practice income with far fewer appointments available for the ill & the 'perceived to be ill worried well'!!

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